Communication Sciences Research Center
The Communication Sciences Research Center (CSRC) conducts and coordinates research in language, reading and hearing difficulties in children. It includes the Reading and Literacy Discovery Center (RLDC) and the Hearing and Listening Center (HEAL), and integrates these collaborative research programs for the Divisions of Audiology, Speech Language Pathology, and General and Community Pediatrics.
In collaboration with other ventures at Cincinnati Children's and in common with the American Academy of Pediatrics, RLDC considers reading to be a public health issue. RLDC receives support from the NIH, foundation and philanthropic funding. The new director of RLDC, John Hutton, MS, MD, delivered research involving a new approach to directly screening early literacy skills in preschool-age children using a children’s book he wrote (Pediatrics, 2019), and a new assessment of screen-based media (e.g. smartphone) use. Dr. Hutton recently completed a clinical trial of a novel, app-based approach to promoting greater parent-child engagement during reading, and is studying a web-based portal for assessing and reporting early literacy skills and risk factors from infancy funded by Read Aloud 15 Minutes, where he serves as national “spokes-doctor.” In collaboration with Tzipi Horowitz-Kraus, PhD, he also explored differences in connectivity of functional brain networks involved with language, imagery and attention during stories in audio, illustrated and animated format in preschool-age children (Brain Connectivity, 2019) and associated with screen-based media use. A study, led by Dr. Horowitz-Kraus, found that mother’s reading fluency associates with greater functional brain connectivity in their 4 year-old daughters learning to read. This led to the inclusion of maternal fluency in an evolving brain model of child language and literacy development (Brain and Cognition, 2019). Dialogic reading training also has a positive effect on preschool children’s executive functions, whereas screen exposure results in a negative effect (Trends Educational Neuroscience, 2019). Finally, Dr Horowitz-Kraus and colleagues demonstrated that children use cognitive control and visual processing networks to read and decode words more efficiently (Cerebral Cortex, 2019) and that children with dyslexia utilize executive functions during both reading and math assignments (Dyslexia, 2019).
Hearing research in CSRC is highly collaborative with other divisions of Cincinnati Children's (e.g. the Divisions of Audiology, Neonatology, Clinical Pharmacology, Pulmonary Medicine, and Speech Language Pathology), the ‘HEAR in Cincinnati’ co-operative, and national and international teams. External funding sources include NIH, foundations and industry. HEAL’s ambitious goals are to develop and deliver novel diagnosis and interventions for listening difficulties, especially applied to infants and young children. Lisa Hunter, FAAA, PhD, is a research audiologist who leads translational hearing research in CSRC and is also scientific director of Cincinnati Children's Division of Audiology. She recently showed that better diagnostic tests dramatically increase accurate and fast detection of hearing loss (Ear and Hearing, 2018), improving our ability to prevent the risk of later learning problems. In an industry collaboration, she and her team discovered important early signs of hearing loss in children with cystic fibrosis undergoing treatment with lifesaving, but ototoxic antibiotics (Ear and Hearing, 2018). These findings should ultimately reduce the prevalence of severe hearing loss in those children. David Moore, PhD, and his listening lab team focus on children who pass normal hearing screening but have a variety of learning problems including language and attention (Ear and Hearing, 2019). Recently, they found impaired functional brain connectivity for language in these children, leading to a search for other processing problems, and a grant from the charity Autism Speaks! Dr Moore’s team also develops new hearing tests, including digits-in-noise (DIN), that can be self-administered via mobile phone and may be the key to addressing underserved populations globally (WHO Bulletin, 2019).
Jennifer Vannest, CF-SLP, PhD, heads speech and language research in CSRC. Dr. Vannest is research speech/language pathologist who is director of the Pediatric Neuroimaging Research Consortium at Cincinnati Children's. She established a track record in functional neuroimaging, linking developmental disorders, including epilepsy (Epilepsy Research, 2019) and diabetes with language and cognitive outcomes. Dr. Vannest receives funding from NIH and the Oticon Foundation, including collaborative grants with Drs. Horowitz-Kraus, Hunter and Moore, and other teams in Cincinnati Children's. Currently, her main research interests are in speech sound disorders, developmental language disorder, hearing and reading. One focus of research is to pioneer the use of functional MRI to investigate language function across typical development: in awake children as young as 3-years old, and sleeping infants. Working with colleagues in the Division of Neurology, recent findings establish that increasing brain activation in language networks and changes in lateralization corresponded to the development of proficiency in language and reading (Human Brain Mapping, 2018). Another study found changes in brain functional organization and connectivity during story listening in children with benign epilepsy (Brain Language, 2017).
Drs. Hunter, Vannest, Hutton and Moore, with Cincinnati Children's colleagues in the Division of Neonatology, are currently submitting a new grant to NIH seeking to link neonatal brain and hearing loss biomarkers to later language development in very preterm babies.
A newly formed employee safety learning laboratory (ESLL) funded by Cincinnati Children's academic and research committee and led by Nancy Daraiseh, PhD, and Maurizio Macaluso, MD, DPH, from the Division of Biostatistics and Epidemiology will serve to effectively and efficiently align our employee safety research program with employee safety operations. The ESLL will have 3 main objectives: 1) improve injury surveillance and develop predictive models to assist our operational leadership with deploying effective preventive interventions; 2) leverage employee safety issues identified by Cincinnati Children's operations to inform new research into prevention strategies; and 3) develop evidence-based interventions that are rigorously tested in research projects and subsequently deployed through quality improvement efforts. Implementation at Cincinnati Children's will positively impact employee experience and retention, quality of patient care, and hospital operating costs. Through the work of the ESLL, we will expand on The Institute of Healthcare Improvement’s Triple Aim framework of enhancing patient experience, improving population health, and reducing costs to respond to the Quadruple Aim framework of improving the quality of work life. The ESLL will be an exemplary application of the Learning Health System model, where real-life problems in healthcare inform research questions that are highly relevant to hospital operations and can demonstrably improve healthcare practice and patient outcomes.
Barbara Giambra, PhD, RN, CPNP, is exploring the effects of parent-nurse communication behaviors in the hospital on parental understanding and management of their ventilator dependent child’s care after discharge to home and the child’s quality of life and clinical outcomes. This work receives support from a NIH K23 grant from the National Institute of Nursing Research. Dr. Giambra hopes this study will lead to the identification and implementation of strategies to improve family management of children with chronic conditions to improve child and family outcomes.
Occupational Therapy and Physical Therapy Research
The Division of Occupational Therapy and Physical Therapy continues to pursue lines of research with the vision to be the leader at improving child health through the systematic generation, adoption and rapid integration of rehabilitation knowledge in order to promote healthy behaviors, engagement in valued activity and improved quality of life. In FY20, the focus continues to be on four strategic goals: 1) Improve outcome, cost and value for patients with neuromuscular and developmental disorders seeking rehabilitation services; 2) Early detection and intervention for infants at risk for cerebral palsy; 3) Become an international leader in the rehabilitation management of patients with mild traumatic brain injury; and 4) Reduce anterior cruciate ligament (ACL) reinjury rates and improve outcomes after discharge from physical therapy following ACL reconstruction.
Dedicated to achieving these goals are the following investigators:
Amy Bailes, PT, PhD, focuses on intervention dose and quality improvement with a particular emphasis on identification of aspects of physical therapy intervention associated with best outcomes for individuals with cerebral palsy.
Karen Harpster, OT, PhD, focuses on implementation of novel therapeutic interventions for infants and children with neurodevelopmental conditions such as cerebral palsy, cortical visual impairment and autism.
Jason Long, PhD, focuses on using biomechanical measures to understand the relationships between neuromuscular and orthopedic impairment, movement abnormalities, and outcomes following surgical or conservative interventions.
Mark Paterno, PT, PhD, focuses on improving outcome after ACL reconstruction through the identification of novel treatment intervention and systems of care focused on optimization of recovery after surgical management of ACL injury.
Central to these goals, the division published over 22 peer reviewed manuscripts in high impact journals such as the American Journal of Sports Medicine, Pediatric Physical Therapy, Developmental Medicine and Child Neurology, Disability and Rehabilitation, Sports Health, Clinical Biomechanics, American Journal of Occupational Therapy, Archives of Physical Medicine and Rehabilitation, and the Journal of Orthopaedic and Sports Physical Therapy. Division investigators successfully procured internal funding, as well as extramural funding, from the National Institutes of Health (NIH) and various foundations.
Laura Ramsey, PhD, is helping to effectively translate discovery into improved clinical care at Cincinnati Children's through pharmacogenetics research. She is the co-director of the Genetic Pharmacology Service, which is working to update its testing platform and launch a new test for tacrolimus dosing based on the CYP3A5 gene. Dr. Ramsey received funding from the Center for Pediatric Genomics to assess outcomes in kidney and liver transplant patients after dosing of the immunosuppressant tacrolimus using the new CYP3A5 test. This year she received two awards: the Annual Meeting Senior Researcher Award from the American Academy of Child & Adolescent Psychiatry and the inaugural Darrell Abernethy Early Stage Investigator Award from the American Society for Clinical Pharmacology & Therapeutics. She published a paper describing the development of the Genetic Pharmacology Service that other institutions are using as a model to develop similar pediatric pharmacogenetic testing programs in the US, Canada, and Israel.
Timothy Phoenix, PhD, and his laboratory continue to develop new tools and treatments aimed at helping to improve the outcome for pediatric brain tumor patients and their families. Funding for his Department of Defense career development award started this past October, which focused on understanding tumor-blood vessel interactions that impact high-grade glioma treatment resistance. Dr. Phoenix received funding from the Matthew “IronMatt" Larson Foundation to perform preclinical studies testing the combination of CDK4/6 inhibitors and immune checkpoint inhibitors in their novel animal models of diffuse intrinsic pontine glioma. Over the past year, Dr. Phoenix presented his research at a number of national and international meetings, including the Cold Spring Harbor blood-brain barrier meeting and Society for Neuro-Oncology Pediatric meeting. He is co-author on one paper using single cell RNA-sequencing technologies to create a transcriptional map of the developing murine cerebellum. Dr. Phoenix also received the Dr. Karen A. Gregerson PY1 Excellence in Teaching Award for his teaching in the PY1 PharmD curriculum at the University of Cincinnati College of Pharmacy.